World Neurosurg
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Intracranial dural arteriovenous fistulas (DAVFs) are an uncommon pathology, and a sphenoparietal drainage pattern is certainly rare. We present a case of a de novo sphenoparietal DAVF in a prepubescent patient previously treated for a cerebellar arteriovenous malformation (AVM) 10 years before. ⋯ This case highlights the different array of presentations that sphenoparietal fistulas may display. Even though most DAVFs are acquired, secondary lesions and spontaneous malformations must be considered in a differential diagnosis.
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Decompression of the culprit artery causing hemifacial spasm (HFS), which passes between the facial nerve (cranial nerve [CN] VII) and the auditory nerve (CN VIII), can be difficult, especially if the artery compresses CN VII right after passing between the 2 nerves. Perforators or small arteries branching from near the compression site to adjacent structures can hinder the decompression process because such vessels can anchor the passing condition. The effect of such perforators or small arteries on the decompression process in such cases was investigated. ⋯ Variation of curvature or tortuosity of the culprit artery and length of perforators or small branches may also have affected the decompression process and the directions. Adequate dissection near the compression site to obtain maximum mobilization of the culprit artery is necessary to achieve successful decompression in such cases.
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The techniques for atlantoaxial arthrodesis have been modified over the years, and placing C1 lateral mass screws is a modern approach. C2 neuropathy is a complication of concern; however, sacrifice of the C2 nerve is an accepted and often favored adjunct. The impact of the technique for cutting the C2 nerve is not adequately addressed in the literature. The aim of this study was to evaluate the clinical outcomes from a series of roots sacrificed during C1-2 fusion with attention to the C2 transection method. ⋯ C2 neuralgia is rare when sharply dividing the C2 root with the aid of bipolar electrocautery at the midportion of the ganglion where it overlies the C1-2 joint. A literature review suggests the impact of the root sacrifice method is an underappreciated modifiable factor in outcome. In future reports, description of the root transection technique is imperative and trials comparing ganglionectomy versus transection proximal to the ganglion or through the ganglion should be considered.
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Serum hyperglycemia and hypophosphatemia have been reported to be common in patients with aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to explore whether admission serum glucose-phosphate ratio was associated with the severity and prognosis of aSAH. ⋯ The study shows that the glucose-phosphate ratio is a potential biomarker that can reflect disease severity and prognosis in aSAH patients.
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Intramedullary schwannomas of the spinal cord are extremely rare. Most previous studies are case reports, which have found that intramedullary schwannomas could be homogeneous or asymmetrically enhanced with gadolinium. However, intramedullary schwannomas with minimal enhancement have not been reported. ⋯ We report a case of intramedullary schwannoma that presented inconspicuous enhancement with gadolinium. MRI is useful but cannot be used to differentiate schwannomas from other intramedullary spinal tumours. Surgical resection is the most vital factor for the treatment of intramedullary schwannoma.